Please use this identifier to cite or link to this item:
https://repository.monashhealth.org/monashhealthjspui/handle/1/36187
Title: | Utility of a Nurse-Led Pathway for Patients with Acute Venous Thromboembolism Discharged on Rivaroxaban: A Prospective Cohort Study. | Authors: | Indran T.;Brown S.;McQuilten Z. ;Tran H. ;Wood E.;Epi M.C.;Chan N.C.;Chunilal S. ;Bennett A. ;Lim M.S.;Cummins A. | Institution: | (Lim, Indran, Cummins, Bennett, Wood, Brown, McQuilten, Chunilal) Department of Haematology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia (Chunilal) Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia (Wood, McQuilten) Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Epi) Australian Centre for Blood Diseases, Monash University, Alfred Medical Research and Educational Precinct, Melbourne, Australia (Epi) Department of Clinical Hematology, Alfred Hospital, Melbourne, Australia (Chan) Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada (Chan) Department of Medicine, McMaster University, Hamilton, ON, Canada | Issue Date: | 12-Mar-2019 | Copyright year: | 2019 | Publisher: | Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com) | Place of publication: | United States | Publication information: | Seminars in Thrombosis and Hemostasis. 45 (2) (pp 187-195), 2019. Date of Publication: 2019. | Journal: | Seminars in Thrombosis and Hemostasis | Abstract: | The highest risk of adverse events for patients with acute venous thromboembolism (VTE) is during the early anticoagulation period. However, no established model exists for early clinical monitoring of patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). The authors' aim was to evaluate the utility of a nurse-led pathway to minimize adverse events in acute VTE patients starting on rivaroxaban. The rivaroxaban VTE treatment pathway is a prospective cohort study of consecutive patients with objectively confirmed VTE between July 2015 and May 2017. Primary outcome was the proportion of patients identified at major risk of adverse events (bleeding or recurrent VTE). Secondary outcomes were rates of interventions, major or clinically relevant nonmajor bleeding (CRNMB), recurrent VTE, and all-cause mortality at 90 days. Among 304 participants, 5% (n = 15) were identified to be at major and 9% (n = 28) at possible risk for adverse events. Appropriate interventions to prevent harm were required in 40 patients. Rates of major bleeding, CRNMB, recurrence, and all-cause mortality were 0.3% (95% confidence interval [CI]: 0.1-1.8), 7.2% (95% CI: 4.8-10.7), 1.0 (95% CI: 0.3-2.9), and 1.6% (95% CI: 0.7-3.8), respectively. In conclusion, following discharge of acute VTE patients, a nurse-led pathway identified one in seven (14%) patients at major or possible risk of adverse events. Preemptive interventions to reduce harm translated into the low rates of bleeding and recurrence. The authors' experience highlights the feasibility and importance of a structured clinical surveillance pathway for acute VTE patients initiating NOAC therapy.Copyright © 2019 Georg Thieme. All rights reserved. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1055/s-0038-1676320 | PubMed URL: | 30566971 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30566971] | ISSN: | 0094-6176 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/36187 | Type: | Article | Subjects: | thrombophilia *venous thromboembolism/dt [Drug Therapy] apixaban/pv [Special Situation for Pharmacovigilance] enoxaparin/pv [Special Situation for Pharmacovigilance] fish oil *rivaroxaban/dt [Drug Therapy] *rivaroxaban/pv [Special Situation for Pharmacovigilance] warfarin/pv [Special Situation for Pharmacovigilance] human adult aged all cause mortality anticoagulant therapy article bleeding body mass clinical outcome cohort analysis deep vein thrombosis female follow up hospital readmission jugular vein thrombosis major clinical study male menorrhagia outcome assessment portal vein thrombosis priority journal prospective study recurrent disease thrombocyte aggregation female follow up hospital readmission human jugular vein thrombosis major clinical study male menorrhagia outcome assessment portal vein thrombosis priority journal aged recurrent disease thrombocyte aggregation thrombophilia *venous thromboembolism / *drug therapy adult prospective study all cause mortality anticoagulant therapy Article bleeding body mass clinical outcome cohort analysis deep vein thrombosis |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
Show full item record
Items in Monash Health Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.